title: Comparison of intermittent intratympanic steroid injection and near-continual transtympanic steroid perfusion as salvage treatments for sudden sensorineural hearing loss.
abstract: OBJECTIVE
  The purpose of this study was to investigate whether near-continual transtympanic steroid perfusion is more effective than intermittent intratympanic steroid injection as a salvage therapy for idiopathic sudden sensorineural hearing loss.
  
  
  METHODS
  Case control study.
  
  
  METHODS
  We designed a case-control study consisting of 60 patients with sudden sensorineural hearing loss who did not respond well to systemic steroid therapy. From November 2008 to October 2010, we prospectively enrolled subjects for the transtympanic steroid perfusion therapy. We retrospectively collected data from age- and sex-matched patients who had undergone intratympanic steroid injection between January 2003 and October 2008. The audiological results of the two groups were compared.
  
  
  RESULTS
  The presalvage pure tone threshold was 65.4 ± 13.5 dB in the transtympanic steroid perfusion group. After the therapy, the hearing threshold was improved by an average of 15.0 ± 9.7 dB, and 53.3% of subjects had improved by 10 dB or more. The speech discrimination score was improved from 12.6% ± 7.0% to 54.4 ± 6.4%. In the intratympanic steroid injection group, the presalvage pure tone threshold was 68.8 ± 16.0 dB. After the therapy, the hearing threshold was improved by an average of 10.7 ± 9.8 dB, and 43.3% of subjects had improved by 10 dB or more. The speech discrimination score was improved from 13.3 ± 6.0% to 46.4 ± 12%. The degree of hearing improvement was significantly greater in the transtympanic group.
  
  
  CONCLUSIONS
  Both transtympanic steroid perfusion and intratympanic steroid injection can be used as salvage therapies for idiopathic sudden sensorineural hearing loss. Near-continual transtympanic steroid perfusions may provide better audiological results.
authors.affiliation: Department of Otolaryngology, Buddhist Tzuchi General Hospital, Taichung Branch, Taichung.
authors.forename: Yi-Fan
authors.initials: YF
authors.lastname: Chou
authors.forename: Peir-Rong
authors.initials: PR
authors.lastname: Chen
authors.forename: Ian-Jiun
authors.initials: IJ
authors.lastname: Kuo
authors.forename: Szu-Hui
authors.initials: SH
authors.lastname: Yu
authors.forename: Yu-Hsuan
authors.initials: YH
authors.lastname: Wen
authors.forename: Hung-Pin
authors.initials: HP
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone / Q000379:methods; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000188:drug therapy*; D003639:Hearing Loss, Sudden / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000187:drug effects* / Q000503:physiopathology
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone
keywords: Idiopathic sudden sensorineural hearing loss; Silverstein MicroWick; intratympanic injection; salvage therapy; steroid; transtympanic steroid perfusion